Boccon-Gibod L, Ravery V, Vordos D, Toublanc M, Delmas V, Boccon-Gibod L
Department of Urology, Bichat-Claude Bernard Hospital, Paris, France.
J Urol. 1998 Oct;160(4):1383-5. doi: 10.1016/s0022-5347(01)62543-6.
We compare the incidence of positive surgical margins in patients who underwent perineal or retropubic radical prostatectomy for clinically localized (stage T1, T2) prostate cancer.
In this retrospective, nonrandomized study we reexamined the specimens of 94 consecutive patients who underwent radical perineal (48) or retropubic (46) prostatectomy for clinically localized prostate cancer (stage T1, T2) and with pathological stage pT2 (intracapsular), pT3A (established extracapsular extension without positive margins) or pT3B (extracapsular extension with positive margins) without lymph node involvement (N0). We assessed the presence or absence of extracapsular cancer with or without positive margins, incisions of the prostatic capsule exposing cancer (surgically induced positive margins) or benign glandular tissue. Patients were followed for 3 to 66 months (mean 25) using an ultrasensitive prostate specific antigen assay with a lower detection limit of less than 0.05 ng./ml.
The overall incidence of positive margins in cancer tissue was 56% in the perineal and 61% in the retropubic group, and biochemical failure-free survival was 67% each. However, surgically induced positive margins in patients with organ confined disease were more frequent in the perineal than retropubic group (43 versus 29%, p < 0.05) and associated with a 37% risk of biochemical failure (prostate specific antigen greater than 0.1 ng./ml.) at mean followup. In addition, capsular incisions exposing benign tissue were more frequent in the perineal than retropubic group (90 versus 37%, p < 0.05) irrespective of pathological stage.
Although overall positive margins and biochemical failure rates are similar or identical for the perineal and retropubic approaches for organ confined prostate cancer, the perineal approach is associated with a significantly higher risk of capsular incisions and surgically induced positive margins and, thus, a higher risk of biochemical failure.
我们比较接受会阴或耻骨后根治性前列腺切除术治疗临床局限性（T1、T2期）前列腺癌患者的手术切缘阳性发生率。
在这项回顾性、非随机研究中，我们重新检查了94例连续接受根治性会阴（48例）或耻骨后（46例）前列腺切除术治疗临床局限性前列腺癌（T1、T2期）且病理分期为pT2（包膜内）、pT3A（已确定包膜外侵犯但切缘阴性）或pT3B（包膜外侵犯且切缘阳性）且无淋巴结转移（N0）患者的标本。我们评估有无包膜外癌伴或不伴切缘阳性、前列腺包膜切口暴露癌组织（手术导致的切缘阳性）或良性腺组织的情况。使用检测下限低于0.05 ng/ml的超敏前列腺特异性抗原检测法对患者进行3至66个月（平均25个月）的随访。
会阴组癌组织切缘阳性的总体发生率为56%，耻骨后组为61%，两组的无生化复发生存率均为67%。然而，器官局限性疾病患者中，会阴组手术导致的切缘阳性比耻骨后组更常见（43%对29%，p<0.05），且在平均随访时与37%的生化复发风险（前列腺特异性抗原大于0.1 ng/ml）相关。此外，无论病理分期如何，会阴组暴露良性组织的包膜切口比耻骨后组更常见（90%对37%，p<0.05）。
尽管对于器官局限性前列腺癌，会阴和耻骨后手术入路的总体切缘阳性率和生化失败率相似或相同，但会阴入路与包膜切口和手术导致的切缘阳性风险显著更高相关，因此生化失败风险也更高。
